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® E V E R E T T PUBLIC WORKS REVIEW WORKSHEET <br /> WASHINGTON <br /> PROJECT ADDRESS: 5128 51ST PL SW Permit#: B2102-061 <br /> TENANT: [TenName] <br /> DESCRIPTION OF WORK: NEW CONSTRUCTION OF SFR BUILD ON VACANT LOT <br /> PW Reviewer to select all that apply below: <br /> Utility Permits (Note:Permit Technicians to Create Utility Permit for Sewer, Water, Fire, and Irrigation, as selected below) <br /> SANITARY SEWER: DOMESTIC WATER SERVICE: (Attach Calculation & Cost Est.) <br /> b-New Connection to main plus r connections to building New Connection, Size .3 ! + - 0 Per Cost Estimate <br /> ❑ Alteration ❑ Meter Only, Size - 0 Per Cost Estimate <br /> ❑ Repair Water System Development Fee Total: $ 4, ( 4 O • o c-) <br /> ❑ Cap-off, quantity Er-Sewer System Development Fee Total: $ .5', 42L.� <br /> ❑ Reconnection to stub 0 Water Service Line (behind meter), Size <br /> ❑ Backwater Valve 0 Backflow Prevention (Outside Building): 0 RPBA or 0 DCVA <br /> ❑ NOT REQUIRED 0 NOT REQUIRED <br /> Explanation/ Utility Permit#: V 2t03- o I Explanation/Utility Permit#: v Ztv3 61 7 <br /> IRRIGATION SERVICE: (Not Including Cost Estimates) FIRE SERVICE: (Attach Cost Estimate/Request for Reference) <br /> ❑ New Connection, Size ❑ New Connection, Size - ❑ Per Cost Estimate <br /> ❑ Meter Only, Size 0 3/4" Detect Meter Only, Service Size <br /> ❑ Water System Development Fee Total: $ 0 Backflow Prevention (Outside Building): 0 DCDA <br /> ❑ Backflow Prevention (Outside Building): 0 DCVA SOT REQUIRED <br /> E-NOT REQUIRED Explanation/ Utility Permit#: <br /> Explanation/ Utility Permit#: <br /> WATER DEPARTMENT COST ESTIMATE NEEDED-(If yes, PW Reviewer to send cost estimate request to Water Department) <br /> ❑ Yes, Quantity , See attached for reference. <br /> RIOT REQUIRED <br /> Plumbing Permits (Note:Permit Technicians to add all items selected below to Plumbing Permit-for items inside building only) <br /> ❑ Backflow Prevention (Inside Building): ❑ DCVA (for Domestic service) 0 RPBA (for Domestic service) ❑ DCDA (for Fire service) <br /> SNOT REQUIRED <br /> Building Permits (Note:Permit Technicians to add all items selected below to associated Building Permit) <br /> STORMWATER SYSTEM DEVELOPMENT FEES: TRAFFIC MITIGATION FEES: <br /> 4-YES, 6-See Attached for calculations/credit DYES, Traffic Mitigation Total: $ .3-i 17.00 <br /> To be added on PW 2 io 4- 03 iN To be added on 0 See Attached for calculations/credit <br /> Quantity charged 3,0 iCc SF Quantity charged SF 0 NOT REQUIRED <br /> QTY is 0 Ground only -all hard surfaces QTY is ❑ Roof only 0 all hard surfaces <br /> $ ,,(o.(419 $ <br /> ❑ NOT REQUIRED <br /> Additional Checklists: <br /> ADDRESS LETTER REQUIRED? (If yes (new assigned address), print out Address Letter from TRAKiT Print Menu and include) <br /> BYES—TYPE: 1:4SFR 0 DUPLEX 0 ADU 0 INFILL DWELLING ❑ MULTI-FAMILY 0 COMMERCIAL <br /> Els See Attached Letter, 2 copies (Permit Techs to issue one copy to applicant with permits, scan one copy to Jeffrey Marks) <br /> Er copy attached to permit record, Permit# ?W Z t n 4-03£ <br /> waved to Address Folder in Development Tech File <br /> ❑ NOT REQUIRED <br /> FIRE SPRINKLERS REQUIRED? <br /> ❑ YES—Type <br /> I -NOT REQUIRED <br /> Reason: <br /> PUBLIC WORKS PERMIT REQUIRED? <br /> DYES, Permit#PW ZI 4•c3 � <br /> 6(LStormwater NPDES Tab Completed in TRAKiT 0DA Tab Completed in TRAKiT 0 Inspections Added in TRAKiT <br /> ❑ NOT REQUIRED <br /> Worksheet Completed By: Date: 6 4-1/2.I2o?_4 <br /> Worksheet Checked By: Date: <br /> REVISED 11/27/2019 <br />